Síndrome de Kounis en envenenamiento por accidente apídico, una revisión narrativa

Diana Lizeth Cabrera-Rojas; Edison Muñoz-Ortiz

doi:10.17533/udea.iatreia.191

Authors

Diana Lizeth Cabrera-Rojas Universidad de Antioquia, Medellín, Colombia https://orcid.org/0000-0002-7373-4780
Edison Muñoz-Ortiz Universidad de Antioquia https://orcid.org/0000-0002-5156-7985

DOI:

https://doi.org/10.17533/udea.iatreia.191

Keywords:

Acute Coronary Syndrome, Bee Venoms, Kounis Syndrome, Myocardial Infarction

Abstract

Kounis syndrome is defined by the appearance of acute coronary events associated to anaphylactic symptoms. The pathophysiological mechanism is still uncertain, however, coronary vasospastic activity secondary to a hypersensitivity type I response is postulated as a triggering factor. In the context of an accident due to a massive bee’s attack, poisoning syndrome also occurs, where the poison components directly damage the myocardium. Kounis syndrome has been reported in SARS-CoV-2 infection, opening the possibility of other mechanisms, among which the cytokine storm stands out. This narrative review aims to consider the mechanisms of damage in Kounis syndrome secondary to poisoning by a massive bee attack and its relationship with the development of short-term complications.

|Abstract

= 675 veces | PDF (ESPAÑOL (ESPAÑA))

= 118 veces| | HTML (ESPAÑOL (ESPAÑA))

= 0 veces|

Downloads

Download data is not yet available.

Author Biographies

Diana Lizeth Cabrera-Rojas, Universidad de Antioquia, Medellín, Colombia

Toxicóloga clínica. Laboratorio Integrado de Medicina Especializada (LIME), Hospital Alma Máter de Antioquia, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Edison Muñoz-Ortiz, Universidad de Antioquia

Internista Cardiólogo, Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia. Unidad Funcional Cardiopulmonar y vascular periférico, Hospital Universitario San Vicente Fundación. Medellín, Colombia. Profesor Universidad de Antioquia, Medellín, Colombia.

References

(1) Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract [Internet]. 1991;45(2):121–8. PMID 1793697.

(2) Clark E. Serum carditis: morphologic cardiac alterations in man associated with serum disease. JAMA [Internet]. 1938;110(14):1098-1100. DOI 10.1001/jama.1938.62790140001008.

(3) Pfister CW, Plice SG. Acute myocardial infarction during a prolonged allergic reaction to penicillin. Am Heart J [Internet]. 1950;40(6):945-47. DOI 10.1016/0002-8703(50)90191-8.

(4) Kounis NG, Cervellin G, Koniari I, Bonfanti L, Dousdampanis P, Charokopos N, et al. Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction? Ann Transl Med [Internet]. 2018;6(17):332–332. DOI 10.21037/atm.2018.09.05.

(5) Kounis NG, Koniari I, Velissaris D, Tzanis G, Hahalis G. Kounis syndrome-not a single-organ arterial disorder but a multisystem and multidisciplinary disease. Balkan Med J [Internet]. 2019;36(4):212–21. DOI 10.4274/balkanmedj.galenos.2019.2019.5.62.

(6) Valderrama-Hernandez R. Envenenamiento causado por picadura de himenópteros:abejas,avispas y hormigas. En: Peña LM, Arroyave CL, Aristizabal JJ, Gomez UE, editor. Fundamentos de medicina: Toxicología Clínica. Medellín: Corporación para Investigaciones Biológicas; 2010. p. 499–535.

(7) Valderrama-Hernandez R. Aspectos toxinológicos y biomédicos del veneno de las abejas Apis mellifera. Iatreia [Internet]. 2003;16(3):217–27. Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/4004.

(8) Mathew A, Chrispal A, David T. Acute myocardial injury and rhabdomyolysis caused by multiple bee stings. J Assoc Physicians India [Internet]. 2011;59:518-20. PMID 21887913.

(9) Schmidt JO. Clinical consequences of toxic envenomations by Hymenoptera. Toxicon [Internet]. 2018;150:96–104. DOI 10.1016/j.toxicon.2018.05.013.

(10) Peña, L, Pineda, M. E, Hernandez, M, Rodriguez-Acosta A. Toxinas Naturales: abejas y sus venenos. Arch Venez Farmacol y Ter [Internet]. 2006;25(1):6–10. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0798-02642006000100001&lng=es.

(11) Gupta PN, Kumar BK, Velappan P, Sudheer MD. Possible complication of bee stings and a review of the cardiac effects of bee stings. BMJ Case Rep [Internet]. 2016;bcr2015213. DOI 10.1136/bcr-2015-213974.

(12) Rao ST, Basappa H, Raveesh H, Hegde S, Manjunath CN. Acute Coronary syndrome following honey bee sting: A series of 6 cases of “kounis syndrome” with literature review. J Indian Coll Cardiol [Internet]. 2021;11(3):98–103. DOI 10.4103/JICC.JICC_34_20.

(13) Kounis NG, Koniari I, de Gregorio C, Assimakopoulos SF, Velissaris D, Hung MY, et al. COVID-19 Disease, Women’s Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay. Biomedicines [Internet]. 2021;9(8):959. DOI 10.3390/biomedicines9080959.

(14) Kounis NG, Koniari I, de Gregorio C. COVID-19 and Kounis Syndrome: Deciphering Their Relationship. Balkan Med J [Internet]. 2021;38(3):145–9. DOI 10.5152/balkanmedj.2021.21097.

(15) Desai R, Parekh T, Patel U, Fong HK, Samani S, Patel C, et al. Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis. Int J Cardiol [Internet]. 2019;292:35–38. DOI 10.1016/j.ijcard.2019.06.002.

(16) Rahimian R, Shirazi FM, Schmidt JO, Klotz SA. Honeybee Stings in the Era of Killer Bees: Anaphylaxis and Toxic Envenomation. Am J Med [Internet]. 2020;133(5):621-626. DOI 10.1016/j.amjmed.2019.10.028.

(17) Karasu E, Minareci K. Myocardial infarction following a bee sting: An example of Type II Kounis syndrome. Int J Cardiol [Internet]. 2011;148(3):382-4. DOI 10.1016/j.ijcard.2010.10.099.

(18) Villamil-Munevar PA, Sanchez-Solanilla LF. Síndrome de Kounis o angina alérgica. Rev Colomb Cardiol [Internet]. 2017;24(4):382–7. DOI 10.1016/j.rccar.2016.10.042.

(19) Geoffroy S, Lambert Y, Fremery A, Marty C, Andre N. Case Report: “Killer Bee” Swarm Attacks in French Guiana: The Importance of Prompt Care. Am J Trop Med Hyg [Internet]. 2021;1051(1):225-229. DOI 10.4269/ajtmh.20-1432.

(20) Galli SJ, Tsai M, Marichal T, Tchougounova E, Reber LL, Pejler G. Approaches for Analyzing the Roles of Mast Cells and Their Proteases In Vivo. I Adv Immunol [Internet]. 2015;126:45-127. DOI 10.1016/bs.ai.2014.11.002.

(21) Palma MS. Hymenoptera Insect Peptides. En: Kastin AJ, editor. Handbook of Biologically Active Peptides. 2nd ed. Academic Press; 2013. p. 416–22.

(22) Kounis NG. Coronary hypersensitivity disorder: The kounis syndrome. Clin Ther [Internet]. 2013;35(5):563–71. DOI 10.1016/j.clinthera.2013.02.022.

(23) Kounis NG, Patsouras N, Grapsas N, Hahalis G. Histamine induced coronary artery spasm, fish consumption and Kounis syndrome. Int J Cardiol [Internet]. 2015;193:39–41. DOI 10.1016/j.ijcard.2015.05.038.

(24) Fletcher JE, Jiang MS. Possible mechanisms of action of cobra snake venom cardiotoxins and bee venom melittin. Toxicon [Internet]. 1993;31(6):669–95. DOI 10.1016/0041-0101(93)90375-s.

(25) Lubawy J, Urbanski A, Mrowczynska L, Matuszewska E, Swiatły-Błaszkiewicz A, Matysiak J, et al. The Influence of Bee Venom Melittin on the Functioning of the Immune System and the Contractile Activity of the Insect Heart—A Preliminary Study. Toxins (Basel) [Internet]. 2019;11(9):494. DOI 10.3390/toxins11090494.

(26) Gasanoff E, Liu Y, Li F, Hanlon P, Garab G. Bee Venom Melittin Disintegrates the Respiration of Mitochondria in Healthy Cells and Lymphoblasts, and Induces the Formation of Non-Bilayer Structures in Model Inner Mitochondrial Membranes. Int J Mol Sci [Internet]. 2021;22(20):11122. DOI 10.3390/ijms222011122.

(27) Kuzmin VS, Malykhina IA, Pustovit KB, Ivanova AD, Kuniewicz M, Walocha J, et al. Inflammatory degranulation of the cardiac resident mast cells suppresses the pacemaking and affects activation pattern in the sinoatrial node. Transl Res Anat [Internet]. 2022;26:100170. DOI 10.1016/j.tria.2022.100170.

(28) Stone SF, Cotterell C, Isbister GK, Holdgate A, Brown SG. Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions. J Allergy Clin Immunol [Internet]. 2009;124(4):786-92.e4. DOI 10.1016/j.jaci.2009.07.055.

(29) Kounis NG, Koniari I, Mplani V, Kouni S, Velissaris D, Plotas P, et al. Rare Hypersensitivity Myocardial Reactions Following COVID-19 Vaccination: Hypersensitivity Myocardial Infarction (Kounis Syndrome) and Hypersensitivity Myocarditis. Anatol J Cardiol [Internet]. 2022;26(3):245–6. DOI 10.5152/AnatolJCardiol.2022.1573.

(30) Kounis NG, Koniari I, Kouni S, Mplani V, Velissaris D, Plotas P, et al. Rare acute hypersensitivity myocardial infarction (Kounis syndrome) and hypersensitivity myocarditis following COVID-19 vaccination. QJM [Internet]. 2022;hcac021. DOI 10.1093/qjmed/hcac021.

(31) Allam C, Kounis NG, Chlawit R, Saouma M, Badaoui G. Kounis syndrome following COVID-19 vaccination. Proc (Bayl Univ Med Cent) [Internet]. 2022;35(3):369-370. DOI 10.1080/08998280.2022.2034226.

(32) Fialho I, Mateus C, Martins-Dos-Santos G, Pita J, Cabanelas N, Baptista SB, et al. Recurrent Kounis syndrome - a life-threatening event after COVID-19 vaccine administration. J Cardiol Cases [Internet]. 2022;25(6):400-403. DOI 10.1016/j.jccase.2022.01.014.

(33) Fajgenbaum DC, June CH. Cytokine Storm. N Engl J Med [Internet]. 2020;383(23):2255–73. DOI 10.1056/NEJMra2026131.

(34) Xia C, Zhang G, Xie J, Liu X. Changes and clinical significance of serum cytokines in patients with bee-sting poisoning. Chinese J Emerg Med [Internet]. 2006;12:wpr-682673. Disponible en: https://pesquisa.bvsalud.org/portal/resource/pt/wpr-682673

(35) Yue C, Chen L, Wang J. Changes of coagulation function and serum cytokines in patients with bee-sting poisoning. Chinese J Gen Pract [Internet]. 2012;(6):939–40. Disponible en: https://pesquisa.bvsalud.org/portal/resource/pt/wpr-429486

(36) Lee HS, Kim YS, Lee KS, Seo HS, Lee CY, Kim KK. Detoxification of Bee Venom Increases Its Anti-inflammatory Activity and Decreases Its Cytotoxicity and Allergenic Activity. Appl Biochem Biotechnol [Internet]. 2021;193:4068–4082. DOI 10.1007/s12010-021-03653-2.

(37) Li F, Liu L, Guo X, Luo Z, Zhang Y, Lu F, et al. Elevated cytokine levels associated with acute kidney injury due to wasp sting. Eur Cytokine Netw [Internet]. 2019;30(1):34–38. DOI 10.1684/ecn.2019.0425.

(38) Alvis-Miranda HR, Duarte-Valdivieso NC, Alcala-Cerra G, Moscote-Salazar LR. Brain Infarction: Rare Neurological Presentation of African Bee Stings. Bull Emerg Trauma [Internet]. 2014;2(1):59-61. PMID 27162866.

(39) Lippi G, Buonocore R, Schirosa F, Cervellin G. Cardiac troponin i is increased in patients admitted to the emergency department with severe allergic reactions. A case-control study. Int J Cardiol [Internet]. 2015;194:68–9. DOI 10.1016/j.ijcard.2015.05.093.

(40) Yanagawa Y, Kondo A, Ishikawa K, Nagasawa H, Takeuchi I, Jitsuiki K, et al. Kounis syndrome should be excluded when physicians treat patients with anaphylaxis. Ann Allergy Asthma Immunol [Internet]. 2017;119(4):392. DOI 10.1016/j.anai.2017.08.003.

(41) Kounis NG. Kounis syndrome: An update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med [Internet]. 2016;54(10):1545–59. DOI 10.1515/cclm-2016-0010.

(42) Cha YS, Kim H, Bang MH, Kim OH, Kim H Il, Cha K, et al. Evaluation of myocardial injury through serum troponin i and echocardiography in anaphylaxis. Am J Emerg Med [Internet]. 2016;34(2):140–4. DOI 10.1016/j.ajem.2015.09.038.

(43) Kounis NG, Mazarakis A, Bardousis C. Myocardial injury through serum troponin I and echocardiography in anaphylaxis: Takotsubo cardiomyopathy and the Kounis hypersensitivity-associated acute coronary syndrome. Am J Emerg Med [Internet]. 2016;34(3):650–1. DOI 10.1016/j.ajem.2015.12.019.

(44) Okur A, Kantarci M, Karaca L, Ogul H, Akoz A, Kizrak Y, et al. The utility of cardiac magnetic resonance imaging in Kounis syndrome. Postep w Kardiol Interwencyjnej [Internet]. 2015;11(3):218–23. DOI 10.5114/pwki.2015.54017.

(45) Goto K, Kasama S, Sato M, Kurabayashi M. Myocardial scintigraphic evidence of Kounis syndrome: What is the aetiology of acute coronary syndrome? Eur Heart J [Internet]. 2016;37(14):1157. DOI 10.1093/eurheartj/ehv703.

(46) Hanashiro PK, Weil MH. Anaphylactic shock in man. Report of two cases with detailed hemodynamic and metabolic studies. Arch Intern Med [Internet]. 1967;119(2):129–40. DOI 10.1001/archinte.119.2.129.

(47) Kohase H, Umino M. Allergic reaction to epinephrine preparation in 2% lidocaine: two case reports. Anesth Prog [Internet]. 2004;51(4):134-7. PMC 2007490.

(48) Kounis NG, Koniari I, Soufras GD, Chourdakis E, Despotopoulos S, Davlouros P, et al. The Humble Relation of Kounis Syndrome, MINOCA (Myocardial Infarction With Nonobstructive Coronary Arteries) and MACE (Major Adverse Cardiac Events). Can J Cardiol [Internet]. 2018;34(8):1089.e7. DOI 10.1016/j.cjca.2018.04.024.

(49) European Society of Cardiology .Guías de práctica clínica [Internet]. 2021 [Consultdo 2021 Apr 30]. Disponible en: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines

(50) Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J [Internet]. 2018;39(2):119–77. DOI 10.1093/eurheartj/ehx393.

(51) Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J [Internet]. 2019;40(2):87–165. DOI 10.1093/eurheartj/ehy394.

(52) Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J [Internet]. 2021;42(14):1289–367. DOI 10.1093/eurheartj/ehaa575.